Provider Demographics
NPI:1669671863
Name:PARKER, TERESA LYNN (APRN)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:LYNN
Last Name:PARKER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:740 E LAUREL RD
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-8601
Mailing Address - Country:US
Mailing Address - Phone:606-330-3404
Mailing Address - Fax:606-330-3100
Practice Address - Street 1:378 THOMPSON POYNTER RD
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-7238
Practice Address - Country:US
Practice Address - Phone:606-877-3990
Practice Address - Fax:606-877-3993
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1093012163W00000X
KY5262P363LF0000X
KY3005262363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50015847OtherPASSPORT HEALTH PLAN
KY11771595OtherCAQH
1669671863OtherNPI
KY7100016200Medicaid
KY000000530365OtherANTHEM
KYC60309OtherCUMBERLAND HEALTHCARE INC
1669671863OtherNPI